Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH.
Joint Implant Surgeons, Inc., New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
J Arthroplasty. 2019 Jan;34(1):145-150. doi: 10.1016/j.arth.2018.09.003. Epub 2018 Sep 12.
Despite growing interest in direct anterior approach total hip arthroplasty, perioperative femoral fracture and early aseptic loosening are increasingly recognized complications. Previous research has documented the role of surgeon experience in association with these femoral complications. The purpose of this study was to explore the relationship between femoral component design and early periprosthetic femoral complications.
This was an extension of previous work with an updated patient cohort of 5090 consecutive direct anterior primary total hip arthroplasties at a single institution with a single-taper, wedge femoral stem comprising 4 variants involving length and geometry: group 1, full-length, standard profile; group 2, full-length, reduced distal profile; group 3, short-length, standard profile; and group 4, short-length, reduced distal profile. Records were reviewed retrospectively for the incidence of early postoperative periprosthetic fracture or aseptic loosening and analyzed with regard to patient demographics and femoral stem type.
There were 42 (0.83%) periprosthetic femur complications observed in the early postoperative period. Increased age (P < .001) and female gender (P = .023) were significantly associated with incidence of femoral complications in univariate analysis, while age maintained this significant relationship in multivariate analysis (P < .001). There was a trend toward increased complication rate in patients receiving a short stem with full profile taper (1.27%, P = .0539).
Despite an overall low rate of femoral complications after direct anterior total hip arthroplasty, the risk is increased in elderly patients and females. Furthermore, femoral stem design may portend an elevated risk of these complications.
尽管对直接前侧入路全髋关节置换术的兴趣日益浓厚，但围手术期股骨骨折和早期无菌性松动已成为越来越被认识到的并发症。先前的研究已经证明了外科医生经验与这些股骨并发症之间的关系。本研究旨在探讨股骨假体设计与早期假体周围股骨并发症之间的关系。
这是以前工作的延伸，在一家机构的 5090 例连续直接前侧初次全髋关节置换术中，更新了患者队列，其中使用了一种单一锥形、楔形股骨柄，包括 4 种涉及长度和几何形状的变体：第 1 组为全长、标准轮廓；第 2 组为全长、远端轮廓减小；第 3 组为短柄、标准轮廓；第 4 组为短柄、远端轮廓减小。回顾性记录术后早期假体周围股骨骨折或无菌性松动的发生率，并分析患者人口统计学和股骨柄类型。
术后早期观察到 42 例（0.83%）假体周围股骨并发症。在单因素分析中，年龄增加（P<.001）和女性性别（P=.023）与股骨并发症的发生率显著相关，而在多因素分析中，年龄仍然保持着这种显著关系（P<.001）。在接受全长标准锥形短柄的患者中，并发症发生率呈上升趋势（1.27%，P=.0539）。
尽管直接前侧全髋关节置换术后股骨并发症的总体发生率较低，但在老年患者和女性中风险增加。此外，股骨柄设计可能预示着这些并发症的风险增加。
